Colorectal cancer (CRC) is the second leading cause of cancer deaths worldwide. Although the overall incidence of CRC is decreasing, the incidence of young-onset CRC, characterized by a diagnosis of CRC before age 50, is increasing. Outcomes for CRC patients are improving, partly due to comprehensive molecular characterization of tumors and novel therapeutic strategies. Advances in genomic and transcriptomic analyses using blood- and tumor-tissue-based sequencing have facilitated identification of distinct tumor subtypes harboring unique biological characteristics and therapeutic vulnerabilities. These insights have led to the development and incorporation of targeted therapies and immunotherapy in CRC treatment. In this review, we discuss the molecular landscape and key oncogenes/tumor suppressors contributing to CRC tumorigenesis, metastasis, and therapeutic resistance. We also discuss personalized therapeutic strategies for subsets of CRC patients and provide an overview of evolving novel treatments being evaluated in clinical trials. Full article

Rising wildfire incidents in South America, potentially exacerbated by climate change, require an exploration of sustainable approaches for fire risk reduction. This study investigates wildfire-prone meteorological conditions and assesses the susceptibility in Colombia’s megadiverse northern region. Utilizing this knowledge, we apply a machine learning model and the Monte Carlo approach to evaluate sustainability strategies for mitigating fire risk. The findings indicate that a substantial number of fires occur in the southern region, especially in the first two seasons of the year, and in the northeast in the last two seasons. Both are characterized by high temperatures, minimal precipitation, strong winds, and dry conditions. The developed model demonstrates significant predictive accuracy with the HIT, FAR, and POC of 87.9%, 28.3%, and 95.7%, respectively, providing insights into the probabilistic aspects of fire development. Various scenarios showed that a decrease in soil temperature reduces the risk mostly in lower altitudes and leaf skin reservoir content in the highest altitudes, as well as in the north region. Sustainability strategies, such as tree belts, agroforestry mosaics, and forest corridors emerge as crucial measures. The results underscore the importance of proactive measures in mitigating wildfire impact, offering actionable insights for crafting effective sustainability strategies amid escalating fire risks. Full article

Objective: We aimed to identify the incidence and risk factors of perianal pathology during pregnancy and the postpartum period. Methods: A prospective cohort study was conducted in three institutions in Lithuania. A total of 190 patients were examined and interviewed three times (<12, 18–20 weeks of gestation, and during the first 2 months after delivery). They completed a questionnaire including demographic, obstetric, coloproctological, and birth data. Results: A total of 73 (34.59%) women developed hemorrhoidal disease after delivery, and 120 (56.87%) developed perianal pathology. Multivariate analysis identified a neonatal birth weight ≥3380 g (OR 4.22; 95% CI 1.83–9.71, p < 0.001) and consumption of eggs (OR 3.10; 95% CI 1.13–8.53, p = 0.028) or cereals (OR 2.87; 95% CI 1.32–6.25, p = 0.008) several times per week as significant risk factors for hemorrhoidal disease. Neonatal birth weight ≥3380 g (OR 3.95; 95% CI 1.47–10.59, p = 0.006), maternal BMI ≥ 21.48 (OR 3.58; 95% CI 1.51–8.47, p = 0.004), the duration of the second labor period ≥38 min (OR 2.81; 95% CI 1.09–7.23, p = 0.032), and consumption of flour products several times per week (OR 2.77; 95% CI 1.10–6.98, p = 0.030) were associated with a higher risk of perianal pathology. Daily consumption of fruits and vegetables (OR 0.35; 95% CI 0.15–0.81, p = 0.014) and less frequent consumption of eggs were protective factors (OR 0.18; 95% CI 0.06–0.56, p = 0.003). Conclusions: Perianal diseases, especially hemorrhoidal disease, are common during pregnancy and the postpartum period. A neonatal birth weight ≥ 3380 g, a maternal BMI of ≥21.48, duration of the second labor period of ≥38 min, and consumption of flour products and cereals several times a week are risk factors for developing these diseases. Full article

Social media platforms have surpassed cultural and linguistic boundaries, thus enabling online communication worldwide. However, the expanded use of various languages has intensified the challenge of online detection of hate speech content. Despite the release of multiple Natural Language Processing (NLP) solutions implementing cutting-edge machine learning techniques, the scarcity of data, especially labeled data, remains a considerable obstacle, which further requires the use of semisupervised approaches along with Generative Artificial Intelligence (Generative AI) techniques. This paper introduces an innovative approach, a multilingual semisupervised model combining Generative Adversarial Networks (GANs) and Pretrained Language Models (PLMs), more precisely mBERT and XLM-RoBERTa. Our approach proves its effectiveness in the detection of hate speech and offensive language in Indo-European languages (in English, German, and Hindi) when employing only 20% annotated data from the HASOC2019 dataset, thereby presenting significantly high performances in each of multilingual, zero-shot crosslingual, and monolingual training scenarios. Our study provides a robust mBERT-based semisupervised GAN model (SS-GAN-mBERT) that outperformed the XLM-RoBERTa-based model (SS-GAN-XLM) and reached an average F1 score boost of 9.23% and an accuracy increase of 5.75% over the baseline semisupervised mBERT model. Full article

Optical hydrogen sensors offer high sensitivity, high accuracy, and non-invasive sensing capabilities, making them promising devices in various fields, including the construction of hydrogen fuel cells, storage and transportation, and aerospace. However, to achieve better sensitivity and faster reaction times, such sensors are often constructed as nano-arrays or nano-gratings, leading to increased manufacturing costs and complexity. In this study, we propose and demonstrate a highly sensitive hydrogen sensor based on a multilayer structure. The proposed structure consists of a Pd metal film and a photonic crystal with a defect layer, in which the photonic crystal is designed by an alternating arrangement of Ta₂O₅ and SiO₂, and the material comprising the defect layer is SiO₂. With a sensitivity of up to 16,020 at 670 nm, the proposed sensor relies on the coupling of Tamm plasmon polaritons and defect modes. The electric field distribution inside the structure is also provided in order to reveal its physical mechanism. Furthermore, we investigate the effects of the thickness of the defect layer and the angle of incident light on the sensor’s performance. The study results show that the sensor has good fault tolerance in either scenario. The findings of this study open up new possibilities for hydrogen sensor applications. Full article

The advancement of both porous materials and nanomaterials has brought about porous nanomaterials. These new materials present advantages both due to their porosity and nano-size: small size apt for micro/nano device integration or in vivo transport, large surface area for guest/target molecule adsorption and interaction, porous channels providing accessibility to active/surface sites, and exposed reactive surface/active sites induced by uncoordinated bonds. These properties prove useful for the development of different porous composition types (metal oxides, silica, zeolites, amorphous oxides, nanoarrays, precious metals, non-precious metals, MOFs, carbon nanostructures, MXenes, and others) through different synthetic procedures—templating, colloidal synthesis, hydrothermal approach, sol-gel route, self-assembly, dealloying, galvanostatic replacement, and so—for different applications, such as catalysis (water-splitting, etc.), biosensing, energy storage (batteries, supercapacitors), actuators, SERS, and bio applications. Here, these are presented according to different material types showing the evolution of the structure design and development towards the formation of hierarchical porous structures, emphasizing that the formation of porous nanostructures came about out of the desire and need to form hierarchical porous nanostructures. Common trends observed across these different composition types include similar (aforementioned) applications and the use of porous nanomaterials as templates/precursors to create novel ones. Towards the end, a discussion on the link between technological advancements and the development of porous nanomaterials paves the way to present future perspectives on these nanomaterials and their hierarchical porous architectures. Together with a summary, these are given in the conclusion. Full article

Due to inadequate resource availability and environmental contamination, the Chinese government has placed a high priority on ecological civilization in recent years. Emphasis has been placed on the environmentally friendly conversion of the economy and the sustainable progress of society. China has established a fiscal decentralization system that divides financial responsibilities between the central and local governments. Due to their proximity advantage, local governments, as agents of the central government, can effectively deliver public services, optimize resource allocation, encourage innovation in green science and technology, and facilitate green growth in the region. However, local governments may exhibit myopic behaviors that impede the sustainable development of the region in their pursuit of regional growth ambitions. Therefore, this paper aims to investigate whether the institutional factor of fiscal decentralization promotes or inhibits the efficiency of green development in China. Using data from Chinese prefecture-level cities between 2010 and 2020, this paper presents the SBM-DDF model to measure the green growth efficiency ($GGE$) in cities. The study then analyzes the spatial impact of fiscal decentralization on $GGE$ using a dynamic panel model and a dynamic SAR model. The empirical results show that China’s green development level has steadily increased in recent years, and $GGE$ reflects climbing pressure and regional differences. Secondly, increasing the vertical fiscal decentralization of local governments promotes $GGE$ growth, while increasing fiscal freedom hinders it. Additionally, fiscal decentralization in neighboring cities also affects local $GGE$, with spatial spillover effects. Finally, the impact of fiscal decentralization on $GGE$ is spatio-temporally heterogeneous. This paper expands on the research regarding the factors that affect the efficiency of green growth in China, specifically focusing on institutional factors at a theoretical level. Additionally, this paper provides targeted policy recommendations based on the aforementioned findings. These recommendations hold great practical significance for China in improving its fiscal decentralization system and achieving sustainable economic development. Full article

The development of high-performance rubber composites has always been a research hotspot in the field of conveyor belt manufacturing. In this work, a rubber cover joint composite made of reduced graphene oxide (rGO) was prepared using latex mixing and mechanical blending methods, with a steel wire rope conveyor belt as the research object, and the influence of the rGO content on the properties of the rubber composite is discussed. The structure and morphology characterization of the rGO/NR rubber show that the addition of rGO does not change its crystal structure, and 1.2 phr rGO is uniformly dispersed throughout the rubber composite. As more rGO is added, the mechanical properties of the rGO rubber cover joint first improve and then worsen. With the addition of 1.2 phr, the cross-linking density increases by 80.6%, the tensile strength of the rubber composites increases by 49.7%, the elongation at break increases by 23.6%, and the adhesion strength increases by 12.4%. The tensile strength of the rGO rubber cover joint can still maintain 72.5% of its pre-thermal aging value. The wear resistance and thermal conductivity increase as more phr is added. When 3.0 phr is added, the wear resistance of the rubber composites increases by 32.9%, the thermal conductivity increases by 118.8%, and the temperature difference at the completion of vulcanization decreases from 4.5 °C to 1.8 °C. The results show that when 1.2 phr of rGO is added, the rubber conveyor belt joint obtains the best comprehensive performance. These enhanced comprehensive properties allow for the practical application of rGO nanomaterials to conveyor belt rubber. Full article

In this report, different handling conditions at slaughterhouse were studied to assess changes in salivary biomarkers. For this purpose, finishing pigs were divided into two groups, one in which handling was improved to minimize stress (Group A, n = 24, transported and stabled at the slaughterhouse at low density without mixing with unfamiliar animals throughout the whole process) and another one in which animals had a more stressful handling process (Group B, n = 24, transported and stabled at high density with unfamiliar animals). Saliva samples were taken the day before transport to the slaughterhouse at 8:00 a.m. (B0) and 12:00 a.m. (B4), and the day of slaughter just after unloading animals at the slaughterhouse at approximately 8:00 a.m. (S0) and after 4 h of lairage at approximately 12:00 a.m. (S4). Group B showed significantly higher cortisol, total esterase activity, oxytocin, adenosine deaminase and haptoglobin levels than the Group A at both S0 and S4 sampling times, and higher levels of calprotectin and creatine kinase at S4 sampling time. This report indicates that differences in the way in which the pigs are handled at the slaughterhouse can lead to changes in salivary biomarkers and opens the possibility of the use of biomarker at slaughter to monitor handling conditions. Full article

The digital application gap and relative poverty caused by the development of digital technology are both important factors affecting sustainable economic dynamics. This paper explores the impact of digital technology development on the relative poverty of urban households in China, using the China Household Tracking Survey CFPS2010–2018 and the word frequency crawling technology of Python software. The results indicate that failure to adapt to the demands of digital technology may result in a multidimensional digital technology application gap, leading to increased income inequality among urban households and a higher likelihood of relative poverty. In economically developed areas, households headed by individuals with low levels of education and high levels of family support should be particularly mindful of the phenomenon of digital poverty. This paper expands the research scope of relative poverty and deepens the understanding of the relationship between digital technology and economic development, which is beneficial for the government to accelerate the construction of internal and external support mechanisms and to effectively address the challenges posed by sustainable economic development. Full article

The presented article studies a metakaolin-based geopolymer matrix for which two types of non-recyclable automotive glass waste (AGW) have been used as an alternative aggregate. Their composition and character, as well as their influence on the properties and structure of geopolymer composites (AGW-Gs), have been investigated by means of X-ray fluorescence and X-ray diffraction analyses, scanning electron microscopy, Fourier transform infrared spectrometry and gas chromatography/mass spectrometry. Infrared analysis has proven that the use of AGW does not affect the formation of geopolymer bonds. GC/MS analysis has revealed the presence of triethylene glycol bis(2-ethylhexanoate) in AGW and geopolymers, whose concentration varied according to the size of the fractions used. Preliminary compressive-strength tests have shown the promising potential of AGW-Gs. From the presented results, based on the study of two types of automotive glass waste, it is possible to assume that automotive glass will generally behave in the same or a similar manner in metakaolin-based geopolymer matrices and can be considered as potential alternative aggregates. The result is promising for the current search for new sources of raw materials, for ensuring resource security, for the promotion of sustainability and innovation and for meeting the needs of the growing world population while reducing dependence on limited resources. Full article

Thermal energy storage (TES) plays an important role in industrial applications with intermittent generation of thermal energy. In particular, the implementation of latent heat thermal energy storage (LHTES) technology in industrial thermal processes has shown promising results, significantly reducing sensible heat losses. However, in order to implement this technology, a proper selection of materials is important. In this study, a new multi-criteria phase change material (PCM) selection methodology is presented, which considers relevant factors from an application and material handling point of view, such as hygroscopicity, metal compatibility (corrosion), level hazard, cost, and thermal and atmospheric stability. The methodology starts after setting up the system requirements where the PCM will be used, then a material screening is able to find all possible candidates that are listed with all available properties as listed before. Then, a color map is produced, with a qualitative assessment of material properties drawbacks, hazard level, melting enthalpy, and price. The experimentation starts with a preliminary set of tests on hygroscopicity and one-week corrosion test, which allows disregarding PCMs and selecting a short list of potential PCMs that would need further characterization before the final selection. Full article

The deployment of Li–S batteries in the commercial sector faces obstacles due to their low electrical conductivity, slow redox reactions, quick fading of capacity, and reduced coulombic efficiency. These issues stem from the “shuttle effect” associated with lithium polysulfides (LiPSs). In this work, a haystack-like CeO₂ derived from a cerium-based metal-organic framework (Ce-MOF) is obtained for the modification of a polypropylene separator. The carbon framework and CeO₂ coexist in this haystack-like structure and contribute to a synergistic effect on the restriction of LiPSs shuttling. The carbon network enhances electron transfer in the conversion of LiPSs, improving the rate performance of the battery. Moreover, CeO₂ enhances the redox kinetics of LiPSs, effectively reducing the “shuttle effect” in Li–S batteries. The Li–S battery with the optimized CeO₂ modified separator shows an initial discharge capacity of 870.7 mAh/g at 2 C, maintaining excellent capacity over 500 cycles. This research offers insights into designing functional separators to mitigate the “shuttle effect” in Li–S batteries. Full article

The cultivation systems of Coffea spp. in a cooperative society in Puebla, Mexico, include Rustic, Traditional Polyculture, Commercial Polyculture, Unshaded Monoculture and Shaded Monoculture. In this work, the properties of the soil were analyzed through physical, chemical and biological analyses to determine its nutritional status. Composite sample analyses were conducted to determine physical, chemical and microbiological parameters (fungi, actinomycetes, mesophilic bacteria, nitrifying and denitrifying bacteria). Leaf nutrients were determined. Rustic was the cropping system with the highest amount of K in the soil and nutrient assimilation in the leaf (N, P, K and Fe) (p = 0.001); in addition, it had high populations of mesophilic bacteria, fungi and actinomycetes and very low nitrification and denitrification rates. The principal component analyses (PCA) (>3.25%) indicated that actinomycetes and K in soil favor the assimilation of Fe, K and P. This Coffea Molina-Monteleón, C.M.; Mauricio-Gutiérrez, A.; Castelán-Vega, R.; Tamariz-Flores, J.V spp. cultivation system generated a lower impact on soil health than the rest of the systems and favored forest ecosystem conservation. Full article

Sphingolipids (SLs) influence several cellular pathways, while vitamin D exerts many extraskeletal effects in addition to its traditional biological functions, including the modulation of calcium homeostasis and bone health. Moreover, Vitamin D and SLs affect the regulation of each others’ metabolism; hence, this study aims to evaluate the relationship between the levels of 25(OH)D and ceramides in acute myocardial infarction (AMI). In particular, the blood abundance of eight ceramides and 25(OH)D was evaluated in 134 AMI patients (aged 68.4 ± 12.0 years, 72% males). A significant inverse correlation between 25(OH)D and both Cer(d18:1/16:0) and Cer(d18:1/18:0) was found; indeed, patients with severe hypovitaminosis D (<10 ng/mL) showed the highest levels of the two investigated ceramides. Moreover, diabetic/dyslipidemic patients with suboptimal levels of 25(OH)D (<30 ng/mL) had higher levels of both the ceramides when compared with the rest of the population. On the other hand, 25(OH)D remained an independent determinant for Cer(d18:1/16:0) (STD Coeff −0.18, t-Value −2, p ≤ 0.05) and Cer(d18:1/18:0) (−0.2, −2.2, p < 0.05). In light of these findings, the crosstalk between sphingolipids and vitamin D may unravel additional mechanisms by which these molecules can influence CV risk in AMI. Full article

Marine microalgae offer a sustainable alternative source for the human diet’s essential omega-3-fatty acids, including docosahexaenoic acid (DHA, C22:6) and eicosapentaenoic acid (EPA, C20:5). However, none of them can produce DHA and EPA in a nutritionally balanced ratio of 1:1. As shown recently, the phototrophic co-cultivation of the golden-brown microalgae Tisochrysis lutea (DHA producer) with the green microalgae Microchloropsis salina (EPA producer) can provide microalgae biomass with a balanced DHA-to-EPA ratio with increased productivity compared to monocultures. This study evaluates whether other golden-brown (Isochrysis galbana) and green microalgae (Nannochloropsis oceanica, Microchloropsis gaditana) can enable the phototrophic batch production of omega-3 fatty acids in a nutritionally balanced ratio in co-culture. All co-cultivations applying a physically dynamic climate simulation of a repeated sunny summer day in Australia in LED-illuminated flat-plate gas lift photobioreactors resulted in increased biomass concentrations compared to their respective monocultures, achieving balanced DHA-to-EPA ratios of almost 1:1. Using urea instead of nitrate as a nitrogen source increased the EPA content by up to 80% in all co-cultures. Light spectra measurements on the light-adverted side of the photobioreactor showed that increased biomass concentrations in co-cultures could have been related to enhanced light use due to the utilization of different wavelengths of the two microalgae strains, especially with the use of green light (500–580 nm) primarily by golden-brown microalgae (I. galbana) and orange light (600–620 nm) predominantly used by green microalgae (N. oceanica). Phototrophic co-cultivation processes thus promise higher areal biomass yields if microalgae are combined with complimentary light-harvesting features. Full article

For large infrastructure projects, such as high-voltage underground cables or for evaluating the very shallow geothermal potential (vSGP) of small-scale horizontal geothermal systems, large-scale geothermal collector systems (LSCs), and fifth generation low temperature district heating and cooling networks (5GDHC), the thermal conductivity (λ) of the subsurface is a decisive soil parameter in terms of dimensioning and design. In the planning phase, when direct measurements of the thermal conductivity are not yet available or possible, λ must therefore often be estimated. Various empirical literature models can be used for this purpose, based on the knowledge of bulk density, moisture content, and grain size distribution. In this study, selected models were validated using 59 series of thermal conductivity measurements performed on soil samples taken from different sites in Germany. By considering different soil texture and moisture categories, a practicable guideline in the form of a decision tree, employed by empirical models to calculate the thermal conductivity of unconsolidated soils, was developed. The Hu et al. (2001) model showed the smallest deviations from the measured values for clayey and silty soils, with an RMSE value of 0.20 W/(m∙K). The Markert et al. (2017) model was determined to be the best-fitting model for sandy soils, with an RMSE value of 0.29 W/(m∙K). Full article

Background and Objectives: The effective management of chronic diseases, particularly hereditary and rare diseases and thalassaemia, is an important indicator of the quality of healthcare systems. We aimed to assess healthcare services in different countries for thalassaemia patients by using publicly available health indicators and by surveying thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources, and we used a structured patient-tailored self-completed questionnaire to survey thalassaemia patients and their caregivers in 2023. Results: A total of 2082 participants were surveyed (mean age, 27 years; males, 42%). About 1 in 4 respondents did not complete high-school education, while 24% had a bachelor’s degree. About a third of respondents were married and were in either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 and 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of services provided, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and that their access to treatment was difficult or very difficult due to traveling expenses and the high cost of treatment. Conclusions: Important improvements in the care of thalassaemia patients have been documented during the past few decades. Nevertheless, additional focus is required through national healthcare systems to effectively address the many unmet needs revealed by our recent survey, as well as to achieve satisfactory patient outcomes. Full article

Background and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. Full article

Aerobic vaginitis (AV) is a distinct clinical entity characterized by inflammation and abnormal vaginal microflora. Often mistaken for bacterial vaginosis, AV remains relatively unknown and underdiagnosed. AV’s understanding is evolving, with some experts suggesting it may primarily be an immunological disorder, the prevalence of which has a range of 7–13% in non-pregnant women and 4.1–8.3% during pregnancy. Pregnancy can affect susceptibility to vaginal infections, leading to adverse outcomes for the woman and the newborn. This review summarizes the correlation between AV and adverse pregnancy outcomes, particularly preterm birth, the leading cause of morbidity and mortality among neonates. An improved understanding of AV’s impact on pregnancy outcomes can lead to early recognition, proper management, and effective interventions. While some studies support an association between AV and preterm labor, the existing knowledge of this relationship remains limited. The evidence suggests that AV may contribute to adverse pregnancy outcomes, mainly preterm birth, but further research is needed to establish a definitive link. Further studies are needed to investigate the underlying mechanisms and clarify AV’s role in premature labor. A comprehensive understanding of AV’s impact on pregnancy outcomes is crucial for early recognition, appropriate management, and effective interventions. Full article

Background and Objectives: The Taiwan Triage and Acuity Scale (TTAS) is reliable for triaging patients in emergency departments in Taiwan; however, most triage decisions are still based on chief complaints. The reverse-shock index (SI) multiplied by the simplified motor score (rSI-sMS) is a more comprehensive approach to triage that combines the SI and a modified consciousness assessment. We investigated the combination of the TTAS and rSI-sMS for triage compared with either parameter alone as well as the SI and modified SI. Materials and Methods: We analyzed 13,144 patients with trauma from the Taipei Tzu Chi Trauma Database. We investigated the prioritization performance of the TTAS, rSI-sMS, and their combination. A subgroup analysis was performed to evaluate the trends in all clinical outcomes for different rSI-sMS values. The sensitivity and specificity of rSI-sMS were investigated at a cutoff value of 4 (based on previous study and the highest score of the Youden Index) in predicting injury severity clinical outcomes under the TTAS system were also investigated. Results: Compared with patients in triage level III, those in triage levels I and II had higher odds ratios for major injury (as indicated by revised trauma score < 7 and injury severity score [ISS] ≥ 16), intensive care unit (ICU) admission, prolonged ICU stay (≥14 days), prolonged hospital stay (≥30 days), and mortality. In all three triage levels, the rSI-sMS < 4 group had severe injury and worse outcomes than the rSI-sMS ≥ 4 group. The TTAS and rSI-sMS had higher area under the receiver operating characteristic curves (AUROCs) for mortality, ICU admission, prolonged ICU stay, and prolonged hospital stay than the SI and modified SI. The combination of the TTAS and rSI-sMS had the highest AUROC for all clinical outcomes. The prediction performance of rSI-sMS < 4 for major injury (ISS ≥ 16) exhibited 81.49% specificity in triage levels I and II and 87.6% specificity in triage level III. The specificity for mortality was 79.2% in triage levels I and II and 87.4% in triage level III. Conclusions: The combination of rSI-sMS and the TTAS yielded superior prioritization performance to TTAS alone. The integration of rSI-sMS and TTAS effectively enhances the efficiency and accuracy of identifying trauma patients at a high risk of mortality. Full article

Neuregulin-1 (Nrg1, gene symbol: Nrg1), a ligand of the ErbB receptor family, promotes intestinal epithelial cell proliferation and repair. However, the dynamics and accurate derivation of Nrg1 expression during colitis remain unclear. By analyzing the public single-cell RNA-sequencing datasets and employing a dextran sulfate sodium (DSS)-induced colitis model, we investigated the cell source of Nrg1 expression and its potential regulator in the process of epithelial healing. Nrg1 was majorly expressed in stem-like fibroblasts arising early in mouse colon after DSS administration, and Nrg1–Erbb3 signaling was identified as a potential mediator of interaction between stem-like fibroblasts and colonic epithelial cells. During the ongoing colitis phase, a significant infiltration of macrophages and neutrophils secreting IL-1β emerged, accompanied by the rise in stem-like fibroblasts that co-expressed Nrg1 and IL-1 receptor 1. By stimulating intestinal or lung fibroblasts with IL-1β in the context of inflammation, we observed a downregulation of Nrg1 expression. Patients with inflammatory bowel disease also exhibited an increase in NRG1⁺IL1R1⁺ fibroblasts and an interaction of NRG1–ERBB between IL1R1⁺ fibroblasts and colonic epithelial cells. This study reveals a novel potential mechanism for mucosal healing after inflammation-induced epithelial injury, in which inflammatory myeloid cell-derived IL-1β suppresses the early regeneration of intestinal tissue by interfering with the secretion of reparative neuregulin-1 by stem-like fibroblasts. Full article